MEDICARE: JODECI MARIE OQUENDO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	6367	CT
2	101YM0800X	Mental Health Counselor	19040	NC

General Provider Information

NPI Number	:	1730617580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODECI MARIE OQUENDO

Provider Business Mailing Address
First Line	:	1235 EAST BLVD STE E1778
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-5870
Country	:	US
Telephone Number	:	860-253-2449
Fax Number	:

Provider Business Practice Location Address
First Line	:	1235 EAST BLVD STE E1778
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-5870
Country	:	US
Telephone Number	:	860-253-2449
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2017
Last Update Date	:	08/19/2025

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